Sunny with a Chance of Clouds

I’ve often said the above phrase, especially when talking about how I’ll probably be on meds for the rest of my life. I don’t mind, really. I’ve accepted it, like others with illnesses who will have to take life-long medication (insulin, high blood pressure meds, blood thinners, etc.). Honestly, I don’t think about the long-term effects. They don’t really matter, I guess. I need the meds to allow me to function as a mostly normal, mostly healthy person. It is what it is.

I’ve been on a particular combination of antidepressants and anti-anxiety meds that have worked for at least a couple of years. Yes, my previous psych doc and I tweaked them a few times, and increased one up and down depending on my emotional situation and ability to handle immediate issues. But it’s been awhile since I had to think about what I was taking. I just take them and live my life.

And it’s all good until one of the meds “poops out.”

The first time that happened was in 2009. The short version of the story is that I had been on the wrong med since I was first diagnosed with depression (1 year) and every time its effectiveness tapered off and we increased the dosage, the improvement time was shorter and shorter. My doc and I added another med which put me into a serotonin toxicity, but the on-call psych doc diagnosed it immediately, and changed my meds. I was hospitalized for a few days – my choice – because I wanted to find the right meds quickly. Even then, it took several months for my body to heal and adjust. But I liked this psych doc tremendously – he helped me with my meds for the next five years, until I moved across the country. I miss him, his knowledge of my brain chemistry sensitivities, his caring and calm demeanor and his gentle approach to changing my meds!

Anyway, back to medications. For anyone unfamiliar with medications taken for mental illness, it is far from a precise science. I’ve read that there exists a simple blood test that could be used to help psych docs quickly determine the type of antidepressant or anti-anxiety med, or the best type of med to treat bi-polar or other mental illnesses, but it is currently not available for use in the U.S. (Different types of meds: not going into details here, but there are Antidepressants – SSRIs, SNRIs, NDRIs, atypicals, NaSSAs, MAOIs, tricyclics;  Anti-anxiety meds; Antipsychotics – including Mood Stabilizers; Stimulants (often used for ADD); and Depressants, just to mention a few classifications. The ones highlighted in blue are all types I have been on at one time or another.)

Since there is no simple way to tell what kind of medicine might work best, doctors prescribe the lowest dose of one that is regarded as potentially successful to the patient’s needs, and then the patient and doctor wait – usually four to six weeks – to see if the med works. Seriously, 4-6 weeks! It’s like finding the right brain medicine with a sledgehammer instead of a scalpel. “Let’s hope this works…Slam!” And if it doesn’t work, then the patient tries another one, for 4-6 weeks. It can be a long difficult process.

A couple of months ago, when my depression started again, my psych doc and I increased one of my antidepressants. It had been working for a long time, and I’d had it at this increased level several years ago and it had been effective – so effective that we were able to reduce it back to my previous level once the depression started improving. But this time, the increase didn’t help. So last month when I met with my psych doc and told him that my mood had not improved, we agreed to increase my other antidepressant. I told him last week when we met that I hadn’t seen any improvement, nor had my husband. The doc felt like I should have noticed an improvement by now. After all, these meds are already in my system, so a boost should have occurred. Instead, nothing. In my opinion, I was maybe even slightly more depressed.

So last week, he reduced one of the antidepressants by 2/3, and I’m to take those until they run out. At the same time, I started on a new med – not an antidepressant but a mood stabilizer. It’s fast acting, so I could know within a week if it’s working. Or in 4-6 weeks.

I admit to being nervous. I was only on a mood stabilizer before and during my hospitalization, when I was being taken off the wrong antidepressant cold turkey. That was then. This is a different reason…because a previously very reliable med has stopped working.

Last week was really tough. Today I wondered if my depressed mood could be because of the reduction of one antidepressant by 2/3. Maybe my body is really missing that med, and the mood stabilizer hasn’t kicked in. I won’t know until the end of this week, at the earliest.

And this is what I wanted to share: finding the right combination of medications is not easy and does not come quickly. It can be a long drawn out process of trial and error and trial and error and trial and … Oh! Maybe this one will work! And the whole time I continue to fight depression, with fewer resources until the right ones can be found.

So I try new meds. And I wait. And I remind myself that I’ve gotten better before. But right now, it looks bleak and dark ahead. Might be awhile before the sun breaks through.

Thanks for reading.